Asphyxiation
by InfinityAndOne
Summary: Ethan's put in charge of the ED and with RageInResus out to ruin him, what starts with a tightness in his chest, ends with him on the floor, not being able to breathe. Set before and kind of during Series 32 Episode 27 (where Alicia comes forward as RageInResus).


_I've been struggling to write this for a few months and because of that, this isn't that great but I hope it's okay and that you enjoy it!_ _Trigger warning for detailed descriptions of anxiety and panic attacks._

* * *

Asphyxiation

It starts with a tightness in his chest. Like someone has grabbed hold of both of his lungs and squeezed them with iron fists. It startles him and worries him when it happens, but the feeling passes after a few moments and he's left with a residual ache in the middle of his chest. He breathes deeply the first time it happens and while his breath catches in his throat for a second, he can breathe normally after that.

The bruise sensation fades completely until a few hours later when the iron hands are back and his lungs compress so much he physically stops breathing for two seconds. But soon after, the hands release his lungs. The ache remains for a while before that goes too.

But one day, the tightness in his chest gets stronger, and it stops him breathing completely. He's never felt dizziness quite like it.

* * *

In the back of his mind, Ethan knows something is wrong. Getting up in the mornings is enough to tighten his chest. Looking at the doors of the ED fills him with dread. Actually talking to the colleagues who are watching him fail and doing nothing but laugh about it is enough to send him to the floor in his office, hand on his chest and breathing so fast he sees black spots.

But in the front of his mind, there is the more pressing matter of running the ED. He already knows he has to prove his worth to Connie. He is, after all, only standing in for clinical lead because they have no-one else. Because no-one else would. Half of his colleagues don't believe he can do it; what happened last time still at the forefront of both his and their minds. And to top it all off, the entire population of Holby has seemed to have hatched a plan to all need hospital treatment at the same time. And Ethan isn't coping. He can't solve the problem, management and Connie don't stop breathing down his neck and he's of no worth to his colleagues unless he's done something wrong. All he seems to be doing is wrong.

And the tightness in his chest not only appears when something goes wrong anymore. It's constant and always there, and at the most random of times, suddenly he cannot breathe anymore.

Yet he pushes through. After all, he can do nothing else. Admitting he can't be the clinical lead of the department would be admitting defeat. His colleagues already doubted his ability to lead the last time he was put in charge of the ED, and he's not redeemed himself yet. And if he gave up now, that would only prove to Connie that he himself, being the last choice of stand-in clinical lead, is justified. That he's not capable of running an emergency department.

And it's not like he can tell someone how much he's struggling. Once upon a time, he would have confided in Alicia. But the tense atmosphere that surrounded them since Cal's death, that only just dissipated, has returned. He maybe would have gone to Charlie as well a while ago, but there's still a part of him that regards Ethan with such disdain it sends shivers down his spine. It doesn't matter that Connie is alright and she's getting better, what matters is that Ethan was the one that kept the secret from everyone else. He won't listen to how Connie had a right to patient confidentiality. He won't listen to anything Ethan has to say on the matter. He's just mostly forgiven him. Emphasis on 'mostly'.

The other people in the department wouldn't care for him either. A couple of years ago he may have gone to Lily, but they have since grown apart. And he doesn't know anyone else well enough to confide in them. If he did, he'd probably just get told to 'man up' and stop complaining.

So here he is, left stranded on an island in the middle of nowhere, his life slipping through his fingers like sand on the palm of his hand.

* * *

Ethan stares at Kam, lying in an ICU bed, on a ventilator and fighting for his life. He does nothing but stares for a few moments, taking in that this was his fault. It happened under his management of the ED. It was like Alicia said – whatever he's doing is not good enough.

His hand moves to his chest as he feels a tightness start to grow there. Kam's slow heartbeat registering on the monitor much slower than his own, which is increasing as the seconds pass slowly. He feels his throat constrict and he screws his eyes shut as he tries to get a breath. For a few seconds he's sure he's going to suffocate, but the background steady beeping grounds him and he slowly returns to normality.

He doesn't stay in the room any longer.

* * *

It continues, painfully not letting him have respite in his waking or dreaming life. The stress of work starts to catch up with him as he sleeps, now only getting a few disrupted hours. His dreams, filled with uncertainty and falling and he often jolts awake at night, seconds before he hits the ground.

Two days later he runs out of coffee.

* * *

The first time he lets it overwhelm him in public is when he shouts at someone; a care home worker in front of her residents. He feels the tightness in his chest get ever more painful, but both his anger and concern take over and suddenly he's shouting. Then she throws it back in his face, mentions the article that he can't seem to forget now.

That's enough to send him to his own office floor, breathing so hard his fingers start to tingle.

* * *

The second time, he manages to leave Connie just in time to half collapse on the stairs to compose himself. It isn't enough for his colleagues to go against him, undermine him and not believe in him; Connie, who isn't even working there currently, has to undermine him too. The feeling of imminent failure creeps up on him again and he's lucky he has enough coordination not to tumble down the stairs as he hyperventilates.

This time, however, his head spins so much he feels like he's going to be sick.

And then, when he composes himself enough to enter the fray of the ED, he brushes off his current, slightly dishevelled state with "nothing I can't handle" to concerned colleagues. Because of course, he can handle it.

He can.

* * *

And while that is called into question many times, when he's sent downwards with his mind going blank and his lungs constricting and his head spinning, Ethan can't let himself believe otherwise. Because the only thing he has left anymore is this – acting clinical lead of the emergency department in Holby City. Take away this, and then he really is on a desert island, alone, afraid and most of all, nothing to nobody.

So when it finally comes to a head, Ethan can feel everything slipping from underneath him and that's it. He's falling without anything to catch him.

* * *

"You look exhausted," is the first phrase that greets him that morning. Honestly, Alicia is not wrong. In between not sleeping because of nightmares and not sleeping on purpose, Ethan has no doubts that he looks halfway to death. But still, what a lovely thing to say.

"Hello to you too."

Alicia rolls her eyes and shuts the office door behind her. "Apparently you didn't go home last night."

Ethan spares her a glance before focusing back on all the admin papers on his desk. "I had too much work to do."

"I can see that."

Ethan looks up again and focuses on where she's looking. Various coffee cups in the bin, admin papers not just on his desk but strewn on his floor too. "Yeah… um, management's been breathing down my neck so…"

There are a few seconds of uncomfortable silence, before Ethan tentatively says, "there's been another blog post."

"Really?" Alicia says, stepping closer.

"According to them, 'the clinical lead of the emergency department is putting lives at risk due to his own stupidity'. He sighs. "Now try telling me it isn't personal."

Alicia hesitates, "at least they didn't name you."

Ethan shakes his head, her attempt to comfort him not working. "I can't lose this job, Alicia."

"You won't."

Ethan scoffed. "You didn't hear Jac Naylor this morning."

A knock on the door interrupts their conversation and Alicia spins around to face the door. Duffy opens it with urgency. "Three car collision on the M50, ETA 3 minutes."

Ethan closes his eyes and tries to breathe past the sudden blockage in his throat, goosebumps form on his skin and he knows that it's only going to go wrong. After all, when Ethan's there, when does anything ever go right?

"Okay. Thanks, Duffy."

* * *

And one hour later, here he is, trying to resuscitate the third patent. He glances at the other two sheet-covered bodies. 12-year-old India Peterson. 24-year-old Hugo Douglas. He looks in the corner at 29-year-old Pamela Peterson, crying for her daughter and boyfriend. He looks at the man standing next to her, 52-year-old Finley Peterson. A broken arm and nothing more, stood comforting his daughter for the loss of his granddaughter. Ethan tried to get in contact with India's father, but he was long gone, died 10 years prior. Hugo's brother – his only family other than his girlfriend – on his way from Leeds.

The second car, the one that crashed into Finley's and killing India and Hugo, is now destroyed. The four passengers killed, two on impact, two because the firemen and paramedics couldn't access them in time. Couldn't put out the fire. Two were quick deaths. Two were slow, painful and full of fear.

But the passports meant Ethan knew them. Because the passports were salvageable and Ethan couldn't restrain himself from asking, from needing to know just _what the hell had happened_. Families were destroyed, lives ripped apart – another victim's life lay in his hands as he pumps desperately on the chest of his patient.

The four poor people, names etched in Ethan's mind; 49-year-old Jeffrey Ashby, 43-year-old Ingrid Taylor, 6-year-old Yasmin Ashby–Taylor and 2-year-old Francesca Ashby–Taylor. Travelling with suitcases and passports and on the M50 to the airport. A holiday they'll never get to.

Then the third and final car, one lone passenger and no next of kin. 67-year-old Alfred Isaac, currently under Ethan's pumping hands.

Because every detail, every patient, every injury and every day, is stuck in Ethan's mind like a broken record player playing a death march. He ca n't forget them; he's hyper-aware of every victim, every misfortune, every death. He can't _not_ remember them.

"Ethan," Alicia says from the side of him. "There's no point."

"Yes, there is," he says breathlessly, with much less certainty than he hoped for. "There's always a point. He's a human being with a _life_."

"It's been too long."

He shakes his head vigorously, his muscles aching and his chest heaving. He's not going to lose a third person today, not when he can save them. Not when he has to save them.

"Ethan."

He glances to the side, enough to see Charlie replace Alicia.

"It's been 36 minutes. It's over."

He shakes his head once more, breathing out a short protest. It's not over. Not until he says it is.

"Dr Hardy," Charlie pushes.

"I'm the clinical lead. It's my call," he pants. "Get ready to shock."

He carries on his rhythm, noticing the lack of movement from his colleagues. With one look up he realises what is happening.

Or what isn't happening, because they were stood still, looking at him with a sadness in their eyes. They're doing nothing.

"Let him go with dignity."

There's nothing about dignity when you're lying on an emergency room bed, dying within white walls with medical professionals standing around you. There is nothing dignified about that.

But he knows what Charlie means. And he can't save him without any help.

He steps down and away, tearing off his gloves and storming out of the room. He hears the small voice of Alicia announce the time of death but its little more than white noise to his quickly dulling senses.

He barely makes it to his office before he collapses down to his knees, dizzy with lack of air.

* * *

He falls back onto the chair behind him, disgust and distaste filling him. She tried to talk to him but he couldn't even look at her. Knowing she was the one who wrote all those… all those horrible things. His closest ally in the civil war of the emergency department and she was no more than the puppeteer.

He couldn't stop the anger boiling over when he shouted at her to get out. And when he hears the door click behind her, the tightness that's become more frequent than normality returns and he breathes so hard he sees moments of whiteness in front of him.

This one lasts the longest it ever has done.

* * *

And then he has the third one of the day. It creeps up on him, slowly, carefully. So he doesn't even notice it's happening until it's already too late.

It starts with a pain in his chest which he puts down to indigestion. He had to wolf down his sandwich at lunch due to an emergency that was being brought it – and Ethan, being clinical lead, knew he had the responsibility to lead it.

He gets to resus just in time to see the two patients.

And then the dread settles in. It's like when Cal used to drive over a hill on the main road that crossed a bridge. He'd accelerate over the peak and just for a second, Ethan's stomach would flip and drop down to the centre of the Earth. Then it would settle. But this was different. The feeling stayed, increased, made him tremble.

It froze him to the spot in the middle of resus and soon after, that's when it finally happened.

Everything crashed down, weighing his heart down with mountains. The whole day – everyone he couldn't save taunting him and everyone he did save forgotten. He stares at the two patients in adjacent beds, bloody and broken. They're unconscious, one of their hearts are too slow, one too fast. He hears his own shaking voice try and give instructions, but he hesitates and stumbles and eventually, Alicia takes pity on him and steps up.

In the back of his mind, Ethan knows that he should be the one in command. But that's fogged up by the rest of his mind, cloudy and grey and panicking. Because neither of the two patients are stable and he can't afford to lose another patient and have another life wasted because he wasn't good enough and everyone knows he's not good enough and that goddamn blog – and _Alicia_ – will tell everyone else how much he failed because he's a failure and everyone knew he was before he even took the job of acting clinical lead and Caleb would be so disappointed in him an–

And for a moment everything stops. He hears his ears ring. He sees nothing but white. He feels complete numbness spread across his body.

Then he reaches it. The peak of panic. As tall as Mount Everest and with as much force as a tidal wave. And the force of the water sends him painfully to his knees as they buckle. He trembles so much he can't see straight. He lists to the side, falling on his right palm. His left hand automatically moves to the pain in his chest, the lightning bolt pan that injects every part of his body. He sees white intermittently amongst the dark spots that float in front of him.

He hears more orders faintly over the rushing sound in his ears and the thumping of his own heartbeat. He blinks tight and rapidly but nothing helps. His throat constricts, reminding him of his childhood nut allergy. And suddenly he realises, terrifyingly, this can't be pure panic. Because he's never experienced panic like this. The sense of dread increases to extraordinary amounts and the realisation hits him so hard he almost falls backwards.

He's dying.

The fog gets too thick around him and his vision nearly deserts him completely. Breathing feels like thousands of knives stabbing his chest over and over again and distantly he realises he just completely stops breathing. Whether consciously or unconsciously he can't tell because right now, all he's focused on is trying to stop his head spinning and get himself in some kind of order because he's dying.

"Ethan?" cuts through the fog so cleanly his head follows the sound. He can barely see now, everything's dark and blurry, and he's unsure of who spoke – if anyone did at all. The spinning in his head increases so much it feels like he's physically spinning around. The tingling in his fingertips spread. "Ethan, you need to breathe."

Everything around him starts to muffle. It's like he's underwater – which actually would explain the knife pain in his chest. It's like he's drowning. Maybe he is drowning.

Distantly he recognises another voice say his name – unsure of who it is but he knows it must be a different person.

Then he falls backwards and he feels the back of his head hit the hard floor. (So he's not underwater then.)

"Charlie, he's hyperventilating!"

His hand is pulled away from his chest and held against something strong and beating. "Ethan, look at me. Focus on me. You're going to be okay, just listen to me."

He doesn't know who's speaking and he doesn't know why. They can't save him – he's going to die and no-one can stop it. He knows.

"Dr Munroe, you need to see to your patient."

"But–"

"I'll calm him down. Ethan, listen to my breathing, okay?"

He doesn't understand the words that float to his ears. It's like the filter from the outside world to his head is clogged. He can hear the sounds of words but he just can't listen.

"You're going to be alright, Ethan. Just listen to my breathing, feel my heartbeat beneath your hand."

He didn't want his death to be this painful.

"You can do it, Ethan."

The voices and sounds dull completely to the distant ringing. He stops breathing. He knows nothing more.

* * *

The first thing he notices is the scratchy surface underneath him. It's not soft, nor is it hard – it's more of a happy medium where it's almost comfortable. He shifts around slightly, opening his eyes slowly and blearily staring straight into a light. Immediately he shuts his eyes again, a groan slipping through his lips at the invasion of his sight.

"Ethan?"

Turning his head towards the sound and opening his eyes once more, he finds himself looking at Charlie. He feels his own brow crease in confusion and he gingerly looks around him.

And then he realises just where he is.

 _Oh._

He feels his cheeks burning red in embarrassment. What on Earth happened to cause him ending up in a cubicle in the ED department that he's running? He stares resolutely away from Charlie. "What happened?" he mumbles.

"You don't remember?"

Ethan's eyes dart around unseeingly as he tries to recall what happened before the blackness he just awoke from. And he hates it when he remembers.

Oh no.

"Yeah, I remember." He sits up slowly, feeling the residual ache in his chest like his lungs were bruised. He had a panic attack. In resus. In front of everyone and somehow he blacked out. He glances at Charlie. "I've got to get back to work."

He swings his legs over the bed but Charlie jumps up and stands by the closed curtain. Thank God for whoever closed that. "We need to talk about some things first."

Ethan groans quietly. "The ED won't run itself, you know."

Charlie glares at him in much the same way Ethan would think a father would glare at his misbehaving son. "It's been running fine for the last hour, I–"

"An hour?" Ethan exclaims incredulously.

"I think it can run itself for the next ten minutes," Charlie finishes, undeterred by Ethan's interruption.

Ethan sighs and rolls his eyes. "Charlie, I'm fine. I just need to get back to work."

"With all due respect, Ethan, you had a panic attack in the middle of resus and passed out because you were hyperventilating." He paused to give an emphasising glare to Ethan. "I think you need to re-evaluate your definition of the word 'fine'."

Ethan huffs and crosses his arms (now he really is the misbehaving son). Charlie motions for him to lean back and Ethan, sensing no escape from this situation, sighs in defeat and regretfully obliges.

"Now come on. What happened?" he asks, returning to his seat.

"Charlie it's really nothing, honestly."

In response, Charlie rolls his eyes and raises his eyebrows, speaking only with his face.

"I've just been a bit stressed recently. That's all."

"That's all?"

"Yes. Can I go now?"

"Ethan," Charlie sighs. "You can talk to me you know."

Ethan breaths out heavily and turns away, his heart starting to break with how _kind_ Charlie sounds.

"I do care."

And then it shatters into a million pieces because he hasn't heard anyone say that and sound like they mean it in a long time.

He can't stop his voice wobbling as he speaks, giving away more of his emotion than he would like. "No you don't," he mutters. "No-one does."

"Ethan?" He hesitates. "Is that what you really believe?"

"It's not a question of what I believe," he says with more conviction than what he feels. "It's about what's true. And that is."

"Of course I care! We all care."

Ethan huffs. "No, you don't. After Cal died I… everyone just seemed to move on. Everyone stopped caring about him and everyone stopped caring about me. Alicia didn't… she didn't care after a while. Then I stupidly thought that maybe, maybe Connie started to care like I cared for her but… well; now she couldn't care less."

"I–"

"She was right you know. Connie. I'm not cut out for this job."

"Yes you are," Charlie says with strength.

Ethan huffs out a laugh. "I'm not. I've lost everyone, Charlie. My family. My friends. My _brother_. And now I think I've finally lost myself."

"We all care, you know. I know it might not seem like it–"

"Charlie everyone hates me. There's even that stupid blog! Set up by Alicia. Can you believe that?"

"You're learning. You make mistakes but you also do things right. You can't be perfect."

Ethan shakes his head. He knows what Charlie's trying to do and it won't work. "Yes, I know that. But all I've done is hurt people and make bad decisions as just prove what everyone thinks."

"And the panic attacks? That wasn't the first one, was it?"

Ethan is silent.

"Ethan, how many have you had?"

He turns away.

"I can't help you if you don't talk to me."

"Who says I want your help?" he bites back bitterly, spinning his head back around in anger, even though he knows he doesn't mean it.

Charlie's silent. Ethan caves in.

"More than I can count, happy now?"

"Ethan… you know that's not healthy, right? And if what happened in resus was any indication, what you've been experiencing is bordering on dangerous."

"Comes with the job."

"No, it doesn't! If this doesn't get sorted you could be _in_ that resus bed."

Ethan shrugs.

"Ethan. Please just tell me honestly. How long has this been going on for?"

And the look in Charlie's eyes makes Ethan finally break. "Long enough to forget how long," he says quietly, exhaling heavily. "I don't… I haven't felt the same, haven't felt like _me_ since Cal. I managed to distract myself, you know? But then I got the chance to be acting clinical lead and I thought _finally_ and can do something. _Be_ something. Top marks to me."

"And the feeling? Are you, have you constantly been feeling anxious? Or do the panic attacks just come on?"

"I… god, it sounds so stupid."

"It's not stupid. Trust me, it's not."

"Just forget it, Charlie I'm being stupid."

Charlie stares at him with only understanding. "Ethan, just talk to me. I'll listen."

"I feel… I feel like I'm falling," Ethan mutters, turning away. "And falling and falling. It's like one of those dreams. You trip over on the pavement and you just fall, then you jump awake." He turns back to Charlie, looking at him with a pained expression. "But I'm not waking up, Charlie. I'm stuck in that dream, falling and falling and falling."

"But we're here to catch you," Charlie says, placing a warm hand on Ethan's knee, the first contact they've had so far. Ethan almost leans more into his touch, feeling some ounce of comfort he hasn't felt in months, but there's a part of his brain that doesn't have the energy to care anymore.

Quickly, he slides his knee from Charlie's hand. "No, you're not. None of you are. You're just there to watch me fail at the only thing I'm good at – the only thing I've got left."

Undeterred from Ethan's cold reception to his touch, Charlie continues on. "Maybe you should take a break from this, Ethan. A break from work."

Ethan looks wide-eyed at Charlie. "I can't."

"You broke down in the middle of resus, Ethan."

"You don't understand, Charlie. This is the only thing I've got! I have no family, no friends, no _life_. Work… it's all I have."

"If it's the only thing you have then you shouldn't have it."

Ethan shook his head. "I need this Charlie. I'm a good doctor. I can do this."

Charlie nods in earnest. "Yes, you are. You're a good doctor. You're a _great_ one, in fact. But Ethan, to be frank, you had a severe panic attack in resus when you should have been treating a patient."

Ethan opens his mouth to interject but Charlie holds a hand up and stalls him.

"It's not healthy, Ethan. You need a break. I know things haven't been easy – first Cal and then all the stuff with Scott. Then Connie getting sick and the pressure that put on you – and I know I didn't help by getting mad at you for not telling anyone what she was going through, which I was wrong about, by the way – and now this blog trying to undermine you at every turn. But Ethan… you're not him, anymore. You're not the good doctor we all know you are. You've been swamped down with management breathing down your neck and, what, trying to prove yourself to everyone? You have nothing to prove. Maybe now just isn't the right time to take on a bigger role. You passed your consultancy exams. Maybe just focus on being a consultant for now – not clinical lead."

Ethan feels a lump in his throat, and before he knows it, he's saying the one thing he promised to himself he would never say. "I've let him down, Charlie."

It takes a moment for Charlie to process, but when it finally happens, Ethan can pinpoint the moment that the realisation washed across his face. "Cal would be proud of you."

"He wouldn't. He saved my life and what have I done to repay him? What have I achieved to make sure his sacrifice was worth it? Nothing. Absolutely nothing. The one thing I'm good at and I failed at that."

Charlie says nothing for a few moments. "Ethan, I know you won't believe me but Cal would be proud of you. Look at everything you did for Connie. Look at everything you did for this department –"

"Yeah, I destroyed it."

"No, you _kept it running_. Much better than anyone else would have done. The board and management and all of the higher powers haven't exactly been easy on you. They tend to forget what it's like to work on the floor, how hard it is. But you kept it running."

Ethan shakes his head. Charlie was right – he doesn't believe him. He only believes what the truth is. "I just… Charlie, I feel so _lonely_. I'm constantly tired and jittery and there's this pit of dread in my stomach that won't go away and I just…" Ethan averts his gaze from Charlie's kind eyes. "Charlie I can't cope with this. I can't cope with any of this, but I've got nothing else."

He could almost feel Charlie's smile. "You've got me. And the rest of the department if you let them. You just need a break. Time to gather your thoughts and collect yourself. Come back better, level-headed. Come back as a consultant, a _good_ one. We can get in another acting clinical lead before Connie returns – and when she does I'll be having stern words – and you can just be Doctor Ethan Hardy. The one we all know and love." He paused. "The one Cal loves."

"I feel like I'm giving up."

Charlie shakes his head. "You're not giving up. You're crossing the finish line with your head held high because this is what's right."

Ethan scoffs. "What's the blog going to say about this?" because he can't imagine Alicia stopping, not after what happened in resus.

"Forget about that thing. I'll sort it out, I'll talk to Alicia, don't worry. We'll get you some time off, maybe some extra help if you need it. And when you come back you'll be okay."

Ethan nods tentatively, logically knowing that maybe that's the better option than continuing and breaking down eventually.

Charlie places a hand on Ethan's shoulder (which he doesn't shrug off) for a moment in silent comfort before getting up to leave.

"Charlie?" he says hesitantly.

"Hmm?" Charlie responds, turning around.

Ethan shrugs and mutters, "I don't really like who I've become either."

Charlie kindly smiles. "You'll be alright, Ethan. I promise."

* * *

And three weeks later, when a calm Ethan returns to work to smiles, a few hugs and a completely deactivated blog, he thinks ' _maybe, maybe things will get better now_ '.

(Cue Leigh–Anne Carr.)

* * *

 _So the movie Spider-Man: Homecoming (I like Marvel so this was bound to happen eventually) had a really great two lines in and I drew a lot of inspiration from those lines in the second to last scene:_

 _Peter Parker: I'm nothing without this suit._

 _Tony Stark: If you're nothing without this suit then you shouldn't have it._


End file.
